Artikel
Severe Hypotony After Glaucoma Filtering Surgery
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Autoren
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Ekaterina Ivanova
- MNTK „Mikrochirurgie des Auges“, Jekaterinburg, Russland
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Dmitry Ivanova
- MNTK „Mikrochirurgie des Auges“, Jekaterinburg, Russland
| Veröffentlicht: | 14. Mai 2019 |
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Gliederung
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Purpose: To develop surgical tactic based on the results of treating severe hypotony after anti-glaucoma surgery.
Patients and methods: A retrospective analysis of 28 eyes of 27 patients (11 females, 16 males) was held. Mean age of patients was 13 to 85 years (55±2). All the patients had severe hypotony after such operations as trabeculectomy – 2; revision of anti-glaucoma surgery zone – 2; transcilliary draining of posterior chamber – 1; nonpenetrating deep sclerectomy – 23 (19 of them after goniopuncture). In 15 cases out of 28 antimetabolites were used.To restore functions the following surgical techniques were used: in 8 cases – suturing the fistula, in 3 cases plastic with a scleral flap, in 17 cases – filling with a fragment of tenon’s capsule. To restore hydrodynamics simultaneous trabeculotomy ab interno was performed in 4 patients and nonpenetrating deep sclerectomy in 5 patients. Nonpenetrating deep sclerectomy as the second stage of treatment was performed in 8 eyes over a period of 1 day to 3 months. 5 patients from the group used hypotensive drops after the operation.
Results: Visual acuity in the group improved from 0,28±0,2 to 0,67±0,15 by one year after surgery. IOP increased from 5,9±2,7 to 14,6 ± 3,2 mm.Hg. There were no signs of maculopathy in any case after 1 year. Based on analysis of the results the following surgical tactics are proposed: Suturing the fistula – conjunctiva and sclera are without signs of serious atrophic changes. Plastic with a scleral flap – the size of the fistula is not more than 1x2 mm, sclera is not changed. Filling with a fragment of tenon’s capsule – serious atrophic changes in the conjunctiva and sclera. Anti-glaucoma component is recommended for suturing and plastic as the second stage, if necessary. In cases of filling simultaneous nonpenetrating deep sclerectomy is recommended in phakic eyes, and trabeculotomy ab interno in pseudophakic eyes.
Conclusion: The proposed tactic proved to be effective and can be used widely in ophthalmic practice.
